We present a life-threatening case of hemothorax resulting from right brachiocephalic vein perforation during right internal jugular vein catheterization. We considered that the guidewire had punctured the right brachiocephalic vein extraluminally and the catheter inserted over the guidewire had enlarged the size of the perforation. Despite the use of proper technique, an angle-tip guidewire may perforate the venous wall. Therefore, when there is negative aspiration after central venous catheterization, it is important to perform an emergency chest radiograph before proceeding with surgery; it is also important not to use an angle-tip guidewire.
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